Refer to our complete list of Required Information to schedule with DiagnosTEX for everything needed to schedule with DiagnosTEX.
Schedule with DiagnosTEX in 3 easy steps!
- Complete the DiagnosTEX Mobile Modified Barium Swallow Study Service Agreement.
You only have to complete this agreement once for your facility. If you've already done this then you can move on to steps 2 and 3.
- Call us at 1-888-514-MBS1 or 817-514-MBS1 to schedule.
- Fax the following information to 817-514-MBS8 or 1-888-514-MBS8:
- Copy of the signed physician’s order for “Dysphagia Consultation including Modified Barium Swallow Study”
- Copy of the Face sheet
- Copy of most recent History and Physical (H&P)
- Completed DiagnosTEX Facility History Intake Form or DiagnosTEX Home Health History Intake Form.
- Signed DiagnosTEX Authorization Form.
- Signed Home Health Patient Acknowledgement Form (for all Home Health Patients).
- Signed DiagnosTEX Observation Consent Form (required).
This form applies to any observers or visitors during the prodecure with the exception of the treating health care professional.
- Copy of Insurance and/or Medicare/Medicaid cards.
DiagnosTEX is a provider for Blue Cross Blue Shields, Pacificare PPO, and Secure Horizons HMO.
- Preauthorization number for any other Private insurance/HMO before scheduling the day and time.
DiagnosTEX is not responsible for obtaining preauthorization numbers, as we do NOT have access to the patient’s medical records and they are currently not under the care of DiagnosTEX.
- The Signed Orders, Face Sheet, copy of Recent H&P, Facility or Home Health History Intake Form, and Authorization Form must be faxed into the office before the study will be scheduled for a day and time. In addition, the Home Health Patient Acknowledgement Form and the DiagnosTEX Observation Consent Form both need to be signed and faxed, if applicable.
Thank you for your assistance. The above items will help expedite the service. We look forward to working with you in providing the best dysphagia care possible. If you have any questions about any of the above information please call 817-514-MBS1 or 1-888-514-MBS1